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WO2018145102A1 - Procédé et appareil permettant de supporter et de stabiliser un patient pendant une hyper-extension de la hanche - Google Patents

Procédé et appareil permettant de supporter et de stabiliser un patient pendant une hyper-extension de la hanche Download PDF

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Publication number
WO2018145102A1
WO2018145102A1 PCT/US2018/017088 US2018017088W WO2018145102A1 WO 2018145102 A1 WO2018145102 A1 WO 2018145102A1 US 2018017088 W US2018017088 W US 2018017088W WO 2018145102 A1 WO2018145102 A1 WO 2018145102A1
Authority
WO
WIPO (PCT)
Prior art keywords
patient
stabilizing pad
extender
surgical
stabilizing
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2018/017088
Other languages
English (en)
Other versions
WO2018145102A9 (fr
Inventor
William Kaiser
James Flom
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Stryker Corp
Original Assignee
Stryker Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Stryker Corp filed Critical Stryker Corp
Priority to CA3052654A priority Critical patent/CA3052654A1/fr
Priority to AU2018214679A priority patent/AU2018214679A1/en
Priority to EP18747256.8A priority patent/EP3576687B1/fr
Publication of WO2018145102A1 publication Critical patent/WO2018145102A1/fr
Publication of WO2018145102A9 publication Critical patent/WO2018145102A9/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/128—Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations
    • A61G13/1285—Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations having modular surface parts, e.g. being replaceable or turnable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/0036—Orthopaedic operating tables
    • A61G13/0081—Orthopaedic operating tables specially adapted for hip surgeries
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205—Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/1245—Knees, upper or lower legs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/126—Rests specially adapted therefor; Arrangements of patient-supporting surfaces with specific supporting surface
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B17/66—Alignment, compression or distraction mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0268—Joint distractors for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0275—Joint distractors for the hip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices ; Anti-rape devices
    • A61F5/37—Restraining devices for the body or for body parts; Restraining shirts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G2203/00—General characteristics of devices
    • A61G2203/30—General characteristics of devices characterised by sensor means
    • A61G2203/42—General characteristics of devices characterised by sensor means for inclination

Definitions

  • This invention relates to medical apparatus in general, and more particularly to medical apparatus for supporting and stabilizing a patient during hip distraction .
  • hip distraction is commonly used
  • a surgical boot is placed on the foot and lower leg of the patient, the surgical boot is connected to a
  • the distraction frame is used to apply a distraction force to the surgical boot, whereby to apply a distraction force to the leg of the patient.
  • a padded post With conventional hip distraction, it is common to provide a padded post between the legs of the patient. This padded post provides a counterforce to the anatomy when the distraction force is applied to the surgical boot.
  • the use of a padded post can create complications, since the padded post can press against the pudendal nerve of the patient, and/or the sciatic nerve of the patient, during distraction. Additionally, the padded post can exert pressure on the blood vessels in the leg of the patient during distraction. Thus, it would be
  • Trendelenburg position e.g., during abdominal surgery.
  • the patient lies on the surgical table "flat on their back", with their feet higher than their head, e.g., by
  • the surgical table is typically tilted so that the patient's head is angled downward and the patient's feet are angled upward.
  • post-less hip distraction One benefit of post-less hip distraction is that there is no post to press against the pudendal nerve of the patient, and/or the sciatic nerve of the patient, and/or the blood vessels of the patient, during distraction.
  • Another benefit of post-less hip distraction is that the non-operative leg remains relaxed while the operative leg is being "pulled on” for distraction. This is because gravity and the friction associated with the tilted surgical table are being used to keep the patient stable on the surgical table, not a post mounted to the surgical table.
  • a post acts as a point of counter-traction; as such, the hip pivots around the post, resulting in a transfer of force to the non- operative leg. Without a post, there is no fulcrum and hence no force is transferred to the non-operative leg. This can benefit the patient inasmuch as any possible risks associated with forces being applied to the non-operative leg (such as neurovascular damage) are eliminated.
  • post-less hip distraction results in less pelvic tilt than conventional distraction using a post.
  • the post acts as a point of counter-traction, it imparts a force on the perineum of the patient, and can act as a fulcrum.
  • the pelvis can rotate around the post. This can result in pelvic tilt, which can be problematic.
  • distraction is used for central compartment work while peripheral compartment work is typically done "off-traction" (i.e., without a
  • the surgical table may be inclined for the portion of the procedure which requires traction (i.e., while work is done in the central compartment), but the surgical table can either be inclined or flat during the portion of the procedure which does not require traction (i.e., while work is done in the peripheral compartment) . This can provide benefits to the surgeon.
  • the post may be removed when traction is not required, such as while work is being done in the peripheral compartment of the hip.
  • traction is not required
  • there are times when it may be necessary to re-introduce the post such as when traction is needed to check on work done in the central compartment, or when a bilateral procedure is performed and traction is needed for the other hip.
  • the patient When the patient is disposed in the Trendelenburg position, gravity acts to pull the patient downward, towards their head, and the body of the patient could slide on the surgical table. Additionally, during post-less hip distraction, the patient could slide on the surgical table when force is applied to the patient's leg in order to effect the hip distraction. For example, the patient could slide distally (i.e., towards their feet) as the leg is pulled distally by the distraction frame. The patient could also slide or roll laterally towards the side edge of the
  • this could be the result of the leg being abducted when the pulling force is applied to the distal end of the leg, thereby generating a lateral force in addition to the distal force.
  • Such unintended movement of the patient's body can disrupt the surgical procedure and/or cause tissue damage. In extreme cases, the patient could even fall off of the surgical table.
  • the present invention is intended to provide new and improved approaches for supporting and stabilizing a patient during hip distraction, both with and without a post. Such approaches are intended to provide improved hip distraction, facilitate post-less hip distraction, minimize pressure on a patient if a post is used, and prevent a patient from sliding or rolling on the surgical table during hip distraction.
  • the present invention provides new and improved approaches for transferring, supporting and
  • Such approaches are intended to provide improved hip distraction, facilitate post-less hip distraction, minimize pressure on a patient if a post is used, and prevent a patient from sliding or rolling on the surgical table during hip distraction. More particularly, the present invention
  • a novel system for transferring, supporting and stabilizing a patient during hip distraction.
  • the novel system generally comprises a table extender for mounting to one end of a surgical table, a stabilizing pad for positioning on the surgical table and the table extender so that the patient resides on the stabilizing pad, and a patient strap for securing the patient to the surgical table. Additionally, the novel system may also comprise a transfer sheet and/or a leg support .
  • a stabilizing pad configured for positioning on a surgical table onto which a patient is placed for a surgical procedure, the stabilizing pad comprising: a high friction top surface; and
  • the stabilizing pad comprises foam
  • a stabilizing pad configured for positioning on a surgical table onto which a patient is placed for a surgical procedure, the stabilizing pad comprising a raised portion extending laterally across the width of the stabilizing pad.
  • a table extender the table extender
  • a proximal portion configured for attachment to a surgical table
  • distal portion of the table extender and the intermediate portion of the table extender are substantially completely radiolucent.
  • a method for positioning a patient for surgery comprising:
  • the table extender positioning the patient on the surgical table and the table extender so that the patient's hip joints are located between approximately 1/3 to approximately 2/3 of the distance along the length of the table extender .
  • a method for positioning a patient for surgery comprising:
  • a method for positioning a patient for surgery comprising:
  • the stabilizing pad disposed on the surgical table at the location that the patient is to occupy during surgery, wherein the stabilizing pad has a high coefficient of friction
  • Figs. 1-4 are schematic views showing one
  • Figs. 5-9, 9A and 9B are schematic views showing further details of the table extender of the novel system shown in Figs. 1-4;
  • Figs. 10 and 11 are schematic views showing further details of the stabilizing pad of the novel system shown in Figs. 1-4;
  • Figs. 11A and 11B are schematic views showing another stabilizing pad formed in accordance with the present invention.
  • Fig. llC is a schematic view showing a transfer sheet which may be used in conjunction with the stabilizing pads of the present invention
  • Fig. 11D is a schematic view showing another transfer sheet which may be used in conjunction with the stabilizing pads of the present invention
  • Figs. 12-14 are schematic views showing another stabilizing pad formed in accordance with the present invention
  • Fig. 15 is a schematic view showing a leg support formed in accordance with the present invention.
  • Fig. 16 is a schematic view showing another leg support formed in accordance with the present
  • Fig. 17 is a schematic view showing a leg support formed as part of the table extender.
  • Fig. 18 is a schematic view showing another leg support formed as part of the table extender.
  • the present invention provides new and improved approaches for transferring, supporting and
  • Such approaches are intended to provide improved hip distraction, facilitate post-less hip distraction, minimize pressure on a patient if a post is used, and prevent a patient from sliding or rolling on the surgical table during hip distraction.
  • Novel System 5 for transferring, supporting and stabilizing a patient during hip distraction. Novel system 5 is intended to provide improved hip distraction,
  • Novel system 5 generally comprises a table extender 10 for mounting to one end of a surgical table 15, a stabilizing pad 20 for positioning on surgical table 15 and table extender 10 so that the patient resides on stabilizing pad 20, and a patient strap 22 for securing the patient to surgical table 15.
  • surgical table 15 is a conventional surgical table of the sort well known in the art. Surgical table 15 typically
  • Platform 35 generally comprises a distal end 36 and a proximal end 37. Platform 35 can generally be tilted in a
  • Side rails 40 typically extend along the sides of platform 35, with side rails 40 being spaced from platform 35 on mounts 45.
  • a cushion 50 is typically disposed on the top surface 52 of platform 35.
  • surgical table 15 is generally formed out of a radiopaque material, e.g., metal.
  • a radiopaque material e.g., metal.
  • table extender 10 for mounting to one end of surgical table 15.
  • table extender 10 is constructed so that patient anatomy supported on table extender 10 can be imaged with X-ray technology through the table extender, thereby enabling CT imaging and X-ray imaging with substantially unlimited angles of view.
  • table extender 10 is sized to support the patient from a point proximal to the hips of the patient to a point proximal to the knees of the patient, whereby to provide optimal support for hip distraction, particularly when the patient is
  • Table extender 10 also provides increased
  • table extender 10 comprises a distal end 53 and a proximal end 54. More particularly, table extender 10
  • base 55 having a distal end 56 and a proximal end 57, a pair of mounts 60 for mounting base 55 to side rails 40 of surgical table 15, and a cushion 65 for disposition on base 55.
  • Base 55 preferably comprises a substantially rigid radiolucent material (e.g., a carbon fiber composite) such that X-ray and/or CT imaging may be performed on the anatomy residing on table extender 10, and base 55 is sufficiently strong to support a substantial portion of the patient's weight. See, for example, Fig. 9, which shows a C-arm X-ray machine 70 disposed about table extender 10 so that C-arm X-ray machine 70 can image anatomy supported on table extender 10.
  • Base 55 of table extender 10 may
  • openings comprise one or more openings, e.g., side openings 75 for enabling easy grasping of table extender 10 during mounting to, and dismounting from, surgical table 15, and/or for receiving straps of stabilizing pad 20 (see below), distal openings 80 for enabling other openings, e.g., side openings 75 for enabling easy grasping of table extender 10 during mounting to, and dismounting from, surgical table 15, and/or for receiving straps of stabilizing pad 20 (see below), distal openings 80 for enabling other openings, e.g., side openings 75 for enabling easy grasping of table extender 10 during mounting to, and dismounting from, surgical table 15, and/or for receiving straps of stabilizing pad 20 (see below), distal openings 80 for enabling other openings, e.g., side openings 75 for enabling easy grasping of table extender 10 during mounting to, and dismounting from, surgical table 15, and/or for receiving straps of stabilizing pad 20 (see below), distal openings 80 for enabling other
  • each of the mounts 60 generally comprises a body 85 mounted to proximal end 57 of base 55 and extending proximally therefrom. Bodies 85 comprise slots 90 for receiving side rails 40 of surgical table 15. Clamps 95 are pivotally mounted to bodies 85, such that clamps 95 can be pivoted towards and away from bodies 85. Clamps 95 preferably
  • mounts 60 comprise friction elements (not shown) which prevent clamps 95 from falling into their locked position until after the user deliberately pushes clamps 95 into their locked position.
  • these friction elements comprise spring plungers which are adjusted so as to provide a degree of resistance to clamps 95 closing into their locked position.
  • other sources of friction or resistance can be utilized such as interference fits between the machined components, ramps, springs, or additional materials such as rubber or silicone added to increase the friction locally.
  • Locking screws 105 extend through bodies 85 and project into slots 90, whereby to enable mounts 60 to be secured to side rails 40 of surgical table 15.
  • Cushion 65 resides on base 55 of table extender 10.
  • Cushion 65 preferably has a thickness (or height) which is substantially the same as the thickness (or height) of cushion 50 of surgical table 15.
  • Cushion 65 is also formed out of a radiolucent material such that X-ray and/or CT imaging may be performed on the anatomy residing on table extender 10.
  • a recess 107 may be provided in the distal portion of cushion 65 so as to expose distal openings 80 in base 55.
  • table extender 10 is nearly completely radiolucent, i.e., the only portions of table extender 10 which are not radiolucent are mounts 60 (which are preferably formed out of a radiopaque metal, e.g., stainless steel) .
  • mounts 60 which are preferably formed out of a radiopaque metal, e.g., stainless steel
  • the only portion of table extender 10 which is not radiolucent in the region extending away from surgical table 15 is the distal portions of mounts 60 (i.e., the portions of bodies 85 of mounts 60 which extend alongside or beneath base 55 of table extender 10) .
  • extender 10 is radiolucent (as viewed from a vertical or anterior/posterior perspective) . In another preferred form of the invention, greater than approximately 80% of the surface area of table
  • extender 10 is radiolucent.
  • the middle and distal portions of table extender 10 are completely radiolucent.
  • the distal sections of mounts 60 do not extend to the middle and distal portions of table extender 10, and there is no metal reinforcement across the width of table extender 10 to support the patient's weight as with existing table extenders.
  • the carbon fiber construction of base 55 of table extender 10 is able to support the weight of the anatomy carried by base 55 without requiring additional structural reinforcements. This is a significant improvement over the prior art as it allows for better imaging and maneuverability of the X-ray equipment; one example of the prior art is U.S. Patent No . 8,944,065.
  • table extender 10 is grasped via side openings 75, and then table extender 10 is moved towards surgical table 15 so that slots 90 of mounts 60 are aligned with side rails 40 of
  • clamps 95 of mounts 60 are pivoted upward relative to bodies 85 of mounts 60 as mounts 60 of table extender 10 are slid over side rails 40 of surgical table 15, with side rails 40 being received in slots 90 of mounts 60.
  • table extender 10 has been properly positioned relative to surgical table 15, clamps 95 are pivoted downwardly so that recesses 100 of clamps 95 seat over mounts 45 of side rails 40.
  • locking screws 105 are used to further secure mounts 60 to side rails 40 (and hence to further secure table extender 10 to surgical table 15) .
  • table extender 10 may be imaged using X-ray and/or CT imaging due to the radiolucency of table extender 10.
  • table extender 10 is preferably sized so as to support the patient from a point proximal to the hips to a point proximal to the knees (see Fig. 1), whereby to provide optimal support for hip
  • table extender 10 comprises an inclinometer 107A to show its angle of incline (and hence to show the angle of incline of surgical table 15) .
  • base 55 of table extender 10 is approximately 18-24 inches long, and more preferably approximately 21 inches long, and approximately 18-24 inches wide, and more preferably approximately 21.25 inches wide.
  • Mounts 60 extend approximately 7 inches along the length of base 55 of table extender 10 (i.e., mounts 60 extend approximately 7 inches distal from the proximal edge of base 55 of table extender 10) .
  • the patient is positioned such that their hip joint is approximately 7-15 inches distal to the proximal edge of base 55 of table extender 10.
  • the patient's hip can be X-ray'd without interference from mounts 60, which is important inasmuch as mounts 60 are typically made of a radiopaque material such as stainless steel.
  • the hip joint is preferably positioned proximal to the distal edge of base 55 of table extender 10; this provides some margin of safety from the possibility of the patient falling off the distal end of table extender 10 in the event the patient's hip moves distally on table extender 10. More particularly, when a distal distraction force is applied to the operative leg of the patient, the hip joint may shift slightly in the direction of the force (i.e., the hip joint may move slightly in the distal direction) .
  • the patient's hip is positioned
  • table extender 10 If the table extender is too long, then more of the patient's body may be placed on the table extender, requiring the table extender to bear
  • table extender 10 may require a distraction system which extends further away from surgical table 15. This is not preferred inasmuch as it generally increases the size and weight of the distraction system, making it more difficult to physically manipulate and manage by the hospital staff; and this is also not preferred inasmuch as the larger distraction system may not fit into some operating rooms (some older facilities have smaller operating rooms) .
  • base 55 of table extender 10 is approximately as long as the average length of a human femur bone (which is approximately 19 inches long) . Stabilizing Pad 20
  • stabilizing pad 20 is provided to cover the top surface of
  • stabilizing pad 20 is shown in the figures as
  • stabilizing pad 20 can terminate at another location, e.g., in the mid- back region of the patient.
  • stabilizing pad 20 comprises a bottom surface 108 for contacting surgical table 15 (i.e., cushion 50 of surgical table 15) and table extender 10 (i.e., cushion 65 of table extender 10), and a top surface 109 for receiving the patient.
  • Bottom surface 108 preferably comprises a high friction material for preventing stabilizing pad 20 from sliding relative to surgical table 15 (i.e., relative to cushion 50 of surgical table 15) and table extender 10 (i.e., relative to cushion 65 of table extender 10) .
  • Top surface 109 preferably comprises a high friction material for preventing a patient from sliding
  • top surface 109 of stabilizing pad 20 is made of a material which is suitable for contacting the skin of a patient, with respect to both patient compatibility and comfort, while also increasing friction with the patient.
  • top surface 109 of stabilizing pad 20 is made of an open cell polyurethane foam.
  • stabilizing pad 20 comprises a foam base 110 (which includes the aforementioned bottom surface 108) and a foam upper 115 (which includes the aforementioned top surface 109) .
  • foam base 110 is sufficiently dense to provide a stable contact with cushion 50 of surgical table 15 and with cushion 65 of table extender 10
  • foam upper 115 is flexible enough to allow the patient to sink into the stabilizing pad, increasing the overall contact and effective frictional resistance to sliding in a relatively stable support structure. It should be noted that some foam materials and shapes may be superior for creating sliding friction against human skin, while other materials and shapes may be superior for creating sliding friction against the top surfaces of surgical table 15 and table extender 10.
  • foam upper 115 is an open cell polyurethane foam comprising an "egg crate" top surface 109 so as to further enhance friction between the patient and stabilizing pad 20 while still being comfortable for contacting the skin of the patient.
  • foam base 110 is preferably a closed cell foam (e.g., ethylene-vinyl acetate (EVA) ) comprising a flat bottom surface 108.
  • EVA ethylene-vinyl acetate
  • foam base 110 has a higher density than foam upper 115.
  • foam base 110 out of a higher density closed cell foam (e.g., ethylene-vinyl acetate (EVA)) and by forming foam upper 115 out of a lower density open cell foam (e.g., polyurethane foam) allows the foam base to provide a stable, high friction foundation on surgical table 15 and allows foam upper 115 to provide a contouring, high friction support beneath and around the patient .
  • a higher density closed cell foam e.g., ethylene-vinyl acetate (EVA)
  • foam upper 115 e.g., polyurethane foam
  • hook-and- loop fasteners 120 are used to secure stabilizing pad 20 to cushion 50 of surgical table 15 and to cushion 65 of table extender 10.
  • straps 125 are used to secure stabilizing pad 20 to surgical table 15 and to table extender 10, for example, securing stabilizing pad 20 to side rails 40 of surgical table 15 and/or side openings 75 of table extender 10.
  • one or more patient straps 22 are also provided to secure the patient to surgical table 15. More particularly, one or more patient straps 22 may be passed over the torso of the patient, under the arms of the patient and attached to surgical table 15. Patient straps 22 prevent the patient from rolling on surgical table 15. Patient straps 22 may also be made so as to prevent the patient from sliding
  • patient straps 22 provide a counterforce to the anatomy during post-less hip distraction.
  • patient straps 22 provide an added margin of safety for the patient during a Trendelenburg procedure when surgical table 15 is tilted so that the patient's head is angled towards the floor and the patient's feet are angled towards the ceiling, i.e., to prevent the patient from sliding or rolling on surgical table 15.
  • patient straps 22 may extend
  • patient straps 22 may be configured for attachment to side rails 40 of surgical table 15, e.g., the ends of patient straps 22 may be provided with hook-and-loop fasteners for securing patient straps 22 to side rails 40 of
  • stabilizing pad 20 further comprises handles (or grips) 126.
  • handles or grips
  • a patient onto, and off of, surgical table 15 e.g., from a gurney
  • the surgical staff slides the patient distally on surgical table 15 until the patient's hips are properly positioned on table extender 10 (e.g., in the manner described above) .
  • the patient's knees will be just off table extender 10 (e.g., in the manner also described above) .
  • this transfer of the patient from a more cephalad position on the surgical table during preparation to a more distal (caudal) position on the surgical table for distraction does not present a problem: most surgical tables have a cushion (e.g., cushion 50) on top of platform 35 of the surgical table, and this cushion can typically accommodate sliding a patient on cushion 50.
  • stabilizing pad 20 has a higher degree of friction than a standard cushion; therefore, it may be too difficult to slide the patient on stabilizing pad 20 and the surgical staff must resort to lifting the patient in order to move the patient relative to surgical table 15 and table extender 10. This is not desirable as it can lead to back injuries for the surgical staff.
  • stabilizing pad 20 comprises handles 126 which can be utilized to slide the
  • Stabilizing pad 20 may comprise reinforcement structures 127 between opposing handles
  • stabilizing pad 20 may comprise a sheet of strong material (not shown) interposed between foam base 110 and foam upper 115, e.g., a strong sheet of material interposed between a foam base 110 and a foam upper 115.
  • stabilizing pad 20 may comprise one or more markings 128 for indicating the preferred location of the patient's hip joints on stabilizing pad 20 in the caudal /cephalad direction. These markings 128 help ensure that, once stabilizing pad 20 (with the patient thereon) is moved to the surgical position, the patient's hip joints will be located on table extender 10 in the preferred position (i.e., proximal to mounts 60 yet spaced from the distal edge of base 55 of table extender 10).
  • a low-friction (e.g., lubricious) transfer sheet 129 (Figs. 11C and 11D) is disposed between the patient and stabilizing pad 20 before and during patient transfer, and then the low-friction (e.g., lubricious) transfer sheet is removed prior to the start of the surgery (including distraction of the hip) .
  • stabilizing pad 20 is placed on, and secured to, surgical table 15 in the surgical position.
  • surgical table 15 In order to slide the patient from the more cephalad initial position (used during patient
  • a low-friction (e.g., lubricious) transfer sheet 129 (Figs. 11C and 11D) can be used.
  • this low-frication (e.g., lubricious) transfer sheet 129 must be removed from beneath the patient after patient transfer and prior to distraction in order to prevent the patient from sliding on the low-friction (e.g., lubricious) transfer sheet during table tilting and/or
  • low- friction (e.g., lubricious) transfer sheet 129 may comprise a split-away construction 129A so that the low-frication (e.g., lubricious) transfer sheet can split into 2 or more sections 129B, 129C which can more easily be removed from under the patient.
  • low-friction (e.g., lubricious) transfer sheet 129 is placed on surgical table 15.
  • low- frication transfer sheet 129 (which rests on surgical table 15) in a typical prep position with their body caudal to the surgical position.
  • the surgical staff then slides the patient down to the surgical position using low- friction (e.g., lubricious) transfer sheet 129.
  • Low- friction transfer sheet 129 is then removed from under the patient using the split-away construction 129A.
  • low-friction (e.g., lubricious) transfer sheet 129 is preferably provided with handles 129D to facilitate movement of the low-friction transfer sheet (and hence movement of a patient disposed on the low-friction transfer sheet 129) .
  • low-friction (e.g., lubricious) transfer sheet 129 may comprise sections 129E and 129F which are initially coupled together via their overlapping handles 129G and which can be pivoted or pulled out from under the patient when the low-friction transfer sheet 129 is to be removed.
  • stabilizing pad 20 may comprise (i) a raised distal section 130 near its distal end, and/or (ii) raised lateral sections 135 on each side of the patient .
  • Raised distal section 130 of stabilizing pad 20 functions as a stop to resist movement of the patient distally, e.g., raised distal section 130 provides a counterforce to the anatomy during hip distraction.
  • Raised lateral sections 135 of stabilizing pad 20 function as lateral stops which resist movement of the patient sliding or rolling laterally, e.g., raised lateral sections 135 add an extra margin of safety for post-less hip distraction where there is no padded post to keep the patient from sliding laterally on surgical table 15.
  • raised lateral sections 135 may limit access to surgical portals and/or restrict hand movements by the surgical team, raised lateral sections 135 may extend along only portions of the patient's sides, e.g., in the case of hip surgery, raised lateral section 135 may extend along the torso of the patient but terminate at, or proximal to, the hip region of the patient.
  • Raised lateral sections 135 are preferably provided on both sides of stabilizing pad 20.
  • stabilizing pad 20 may provide a raised lateral section 135 on only one side of the patient, e.g., on the operative leg side of the patient, or on the non-operative leg side of the patient .
  • stabilizing pad 20 may be constructed out of a gel material (e.g., a gel material such as that used to form cushions 50 and 65) so as to give raised sections 130 and/or 135 the requisite firmness.
  • a gel material e.g., a gel material such as that used to form cushions 50 and 65
  • the stabilizing pad may be formed out of a material which is not a high friction material.
  • a stabilizing pad 20 comprising raised sections 130 and/or 135 may also be constructed out of high friction materials such as is described above, so as to further prevent the patient from sliding on the stabilizing pad.
  • a hip arthroscopy surgical patient is typically brought into the operating room on a gurney, then transferred to the surgical table with, for example, a transfer board or transfer sheet.
  • a transfer board or transfer sheet In a hip
  • the patient is typically transferred to a position on the table that supports most, if not all, of the full body length of the patient. Subsequently, the patient is moved distally when the feet are ready to be secured to the surgical boots of the distraction system.
  • the patient is transferred directly to their final position on the surgical table (i.e., the position the patient will be in for surgery) .
  • the surgical table i.e., the position the patient will be in for surgery
  • this often involves a portion of the legs being suspended (i.e., the patient's torso and thighs may be on the surgical table, and the patient's feet may be suspended at the distal end of the surgical table) .
  • stabilizing pad 20 may be set in its surgical position at the time the patient is to place themselves on the surgical table, with stabilizing pad 20 comprising markings 128 indicating the desired position for the patient's hip joints.
  • the legs of the patient extend past distal end 53 of table extender 10 and are unsupported for a time period prior to being secured to the surgical boots of the distraction system. This is undesirable as it may be
  • leg support 140 can be provided to support the patient's legs until such time as the patient's legs are secured in the distraction apparatus.
  • leg support 140 is a tray which mounts to distal end 53 of table extender 10 and extends distally of table extender 10.
  • leg support 140 may mount to surgical table 15 and extend distally of table extender 10.
  • Leg support 140 may also have a support (not shown) which extends to the floor for additional support.
  • leg support 140 comprises a board or boards which mount to the distraction apparatus.
  • leg support 140 may be readily connected to, and disconnected from, table extender 10, surgical table 15 or the distraction apparatus .
  • leg support 140 is incorporated into table extender 10 itself; for example, leg support 140 may be in the form of a pivoting member which pivots relative to base 55 of the table extender (see Fig. 17), or leg support 140 may be in the form of a sliding member which slides and raises into a cantilevered position relative to base 55 of the table extender (see Fig. 18) .
  • leg support 140 extends between 15 and 30 inches from the distal edge of table extender 10. In one preferred form of the invention, leg support 140 extends approximately 20 inches from the distal edge of table extender 10.
  • a patient can also be positioned in a lateral decubitus position on the surgical table as opposed to a supine position .

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  • Health & Medical Sciences (AREA)
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  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Accommodation For Nursing Or Treatment Tables (AREA)

Abstract

La présente invention concerne une plaquette de stabilisation conçue pour être positionnée sur une table chirurgicale sur laquelle est placé un patient pour une intervention chirurgicale, la plaquette de stabilisation comprenant : une surface supérieure à coefficient de friction élevé ; et une surface inférieure à coefficient de friction élevé ; la plaquette de stabilisation comprenant de la mousse.
PCT/US2018/017088 2017-02-06 2018-02-06 Procédé et appareil permettant de supporter et de stabiliser un patient pendant une hyper-extension de la hanche Ceased WO2018145102A1 (fr)

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CA3052654A CA3052654A1 (fr) 2017-02-06 2018-02-06 Procede et appareil permettant de supporter et de stabiliser un patient pendant une hyper-extension de la hanche
AU2018214679A AU2018214679A1 (en) 2017-02-06 2018-02-06 Method and apparatus for supporting and stabilizing a patient during hip distraction
EP18747256.8A EP3576687B1 (fr) 2017-02-06 2018-02-06 Procédé et appareil permettant de supporter et de stabiliser un patient pendant une hyper-extension de la hanche

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US201762455143P 2017-02-06 2017-02-06
US62/455,143 2017-02-06
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US20240099919A1 (en) 2024-03-28
WO2018145102A9 (fr) 2019-06-06
EP3576687A1 (fr) 2019-12-11
EP3576687B1 (fr) 2025-07-02
AU2018214679A2 (en) 2019-10-10
US11684532B2 (en) 2023-06-27
AU2018214679A1 (en) 2019-08-29
CA3052654A1 (fr) 2018-08-09
US20180221229A1 (en) 2018-08-09

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